The diagnostic and therapeutic utility of endoscopic ultrasound in pancreatic and bile duct disorders
Keczer Bánk
Clinical Medicine
Dr. Reusz György
Semmelweis Egyetem, Transzplantációs és Sebészeti Klinika
2024-12-16 14:00:00
Gastroenterology
Dr. Molnár Béla
Dr. Hritz István
Dr. Iliás Ákos
Dr. Papp András
Dr. Kiss András
Dr. Lintner Balázs
Dr. Gyökeres Tibor
The EUS is a highly sensitive and accurate diagnostic tool for detecting and evaluating choledocholithiasis, even in cases where the previous US examination did not confirm the presence of biliary tract stones. The sensitivity of clinical predictors for estimating biliary tract stones are far from satisfactory. The possible predictive ability of clinical parameters determined by the modified 2019 (or the 2010) ASGE guideline for the detection of choledocholithiasis could not be proved in our study.
The EUS-guided drainage of PFCs demonstrates a high level of technical and clinical success, regardless of the choice between LAMS or DPPS. While the incidence of early complications was comparable for both stent types, it is noteworthy that there was a slightly higher incidence in the LAMS group, although this difference did not reach statistical significance. Nevertheless, it is also essential to highlight, that the drainage duration required for PFCs was significantly lower in the LAMS cohort.
During the analysis of EUS images of pancreatic cystic lesions, there was no significant difference in the overall lesion size; however, significant differences were found in the dimensions of the cystic components. The presently existing guidelines solely rely on the overall lesion size and do not account for the differentiation based on the lesion's area ratio. Pseudocysts typically feature predominantly cyst walls, while MCNs exhibit a higher proportion of solid components. Furthermore, concerning features like thickened or enhancing cyst walls lack quantification and standardization in the guidelines, which makes their interpretation challenging. In our study, we quantified the echogenicity of distinct lesion components, and the considerable variances in these parameters may offer valuable insights for guiding clinical decision-making processes. Nonetheless, further scientific investigation is warranted to validate these findings. The software analysis of EUS images may hold promise as a novel diagnostic tool for assessing and distinguishing pancreatic cystic lesions. Moreover, it could expand the role of artificial intelligence in the diagnosis of gastrointestinal disorders. However, further comprehensive research is recommended to validate the clinical effectiveness and precision of the EUS image analysis methods.
